This Common Nighttime Habit Can Be a Sign of Disease

Picture this: You’re fast asleep and in the middle of a great dream, when an uncomfortable feeling jolts you awake. It’s your bladder calling, telling you it’s time to use the bathroom. Of course, waking up to pee at night happens to everyone occasionally. But if it’s happening more than once a night, it could be a sign of an underlying health issue. 

“You should be able to sleep about six to eight hours without waking up to go to the bathroom,” says urologist Justin Dubin, M.D. “If you’re waking up two or more times per night, that’s considered abnormal.” 

The medical term for those excessive bathroom breaks is nocturia. While nocturia itself isn’t a disease, it can be a symptom of one. And it’s more common than you might think, affecting 50 million adults in the U.S. Most are over age 65, but even 1 in 3 of those over 30 say they get up to pee two or more times nightly. 

Should you be concerned? To find out, we spoke to urologists and a dietitian about conditions that can cause those nighttime bathroom trips, what’s considered normal, plus practical tips to prevent them.

Conditions That Cause Excessive Nighttime Peeing

There are many potential causes of excessive nighttime urination, including lifestyle habits, bladder capacity, some medications and underlying health conditions. Here are four of the most common health issues that might be the culprit. 

Diabetes

If you find yourself waking up to use the bathroom more often than usual, it could be one of the first signs of blood sugar troubles. Frequent urination is one of the early signs of diabetes, says urologist Scott D. Miller, M.D., M.B.A., a diagnosis he makes several times each year. 

An estimated 15% of American adults are living with diabetes, and roughly 3% are unaware of it. When diabetes goes undiagnosed or is poorly managed, elevated blood sugar levels can lead to more frequent visits to the bathroom. 

How does it happen? “Elevated blood glucose levels can trigger osmotic diuresis, resulting in excessive nighttime urination,” says Elizabeth Shaw, M.S., RDN, CPT. This is when the kidneys try to lower blood sugar by pulling excess glucose into the urine, and water follows. “This leads to increased urine production around the clock, including overnight,” adds Miller. 

Sleep Apnea

“Many patients are surprised to learn their bladder symptoms are actually sleep-related,” says Miller. One to look out for is sleep apnea. “Sleep apnea occurs when the throat muscles relax during sleep and block breathing, causing people to wake up repeatedly during the night,” says Shaw. Tip-offs that you have it are snoring or gasping for air while you sleep. 

Sleep apnea can also be a sneaky reason you’re getting up to use the bathroom. Beyond disrupting sleep, sleep apnea can lower oxygen levels in the blood, which triggers hormone changes that encourage nighttime urination production, says Miller. Specifically, it leads to increased secretion of atrial natriuretic peptide (ANP), a hormone that helps your kidneys excrete water from the body. 

Overactive Bladder

If you find you’re going to the bathroom frequently throughout the day and more than twice per night, you might have an overactive bladder. “Overactive bladder is a condition in which the bladder is oversensitive and sends frequent or sudden signals to urinate, even when it isn’t full, leading to urgency and frequent bathroom trips day or night,” explains Miller. The good news is that there are medications that can help calm your bladder. So, if you are always running to the bathroom, speak with your health care provider. 

Benign Prostatic Hyperplasia

As men get older, the prostate gland naturally grows. This condition is called benign prostatic hyperplasia (BPH). “When the prostate is enlarged, you can’t empty your bladder as well, so your [bladder] may feel more full more frequently, and the time for you to tolerate holding in urination can decrease,” explains Dubin. Fortunately, for many men, lifestyle changes can help (more on this soon!).

What Is Normal?

For most adults, up to one nighttime bathroom trip is considered normal. Consistently waking two or more times per night (especially if it’s new, worsening or exhausting) deserves a medical visit, says Miller. 

“You should be concerned anytime nocturia disrupts sleep or daytime energy,” he says. “When nocturia occurs suddenly or is associated with urinary pain, excessive thirst, leg swelling or shortness of breath, you should promptly seek medical attention.” 

Tips to Reduce Peeing at Night

In addition to working with your health care provider to find out the cause of those nighttime bathroom trips, experts recommend trying these tips.

• Stop drinking two hours before bed: Cut back on all fluids two hours before bedtime, especially alcoholic and caffeinated drinks, says Dubin. Both alcohol and caffeine are diuretics that can cause you to urinate more frequently. 
• Check your medications: Some medications, like diuretics for high blood pressure or heart conditions, can increase urination. For men with BPH, some antihistamines and over-the-counter cold meds can also be triggers. Ask your health care provider whether it’s possible to take these medications in the morning instead of the evening, or if there is an alternate medication that might work for you. 
• Treat underlying conditions: Untreated sleep apnea and diabetes can worsen sleep and increase urination. “It’s best to get these under control to help peeing at night and sleep better,” says Dubin. 
• Address leg swelling: Your legs can swell at night for various reasons. Some can be serious, which is why you should never ignore it. But there are also benign culprits, like standing or sitting too long during the day, taking certain medications, or eating lots of salty foods. Swollen legs can also make you need to pee frequently. “Elevating the legs or wearing compression socks in the evening can help shift fluid earlier, reducing nighttime urine production,” says Miller. 

Our Expert Take

It’s normal to wake up at night to pee occasionally. But if it happens more than twice a night, it could be your body trying to tell you there’s a problem. “Waking up at night to urinate may not be just a bladder issue, it can be your body’s way of raising a red flag,” says Miller. 

Conditions like diabetes, sleep apnea, overactive bladder and benign prostate hyperplasia can all make you need to pee frequently throughout the night. While one nightly trip to the bathroom is considered normal, anything more might indicate an underlying issue. So, be sure to let your health care provider know. In addition to treating underlying health conditions, experts recommend cutting back on fluids two hours before bedtime, reviewing your medications with your health care provider and addressing leg swelling. In return, you might cut down on those nightly bathroom trips and finally get the rest you need.